Convenient shoulder arthroplasty solutions for patients with glenoid bone loss
Today at the 2021 American Academy of Orthopedic Surgeons (AAOS) annual meeting, Hospital for Special Surgery (HSS) sports medicine surgeon David M. Dines, MD, participated in a conference educational case study on practical solutions in shoulder arthroplasty for patients with significant shoulder alveolar bone loss known as glenoid bone deficiency. The interactive session provided an interesting opportunity for attendees to learn about the latest imaging and diagnostic methods, presurgical planning tools, and arthroscopic techniques and implants, including patient-specific convertible implants.
The glenoid is the hollow part of the shoulder joint that connects to the ball of the arm bone. Glenoid bone loss can occur due to severe arthritis, traumatic injury, or repetitive overuse in sports like baseball or swimming. It can also occur as a result of a failure of a previous surgical procedure. Symptoms associated with glenoid bone loss include inflammation, pain, and decreased function of the shoulder.
Shoulder arthroplasty to treat glenoid deficiency is a very hot topic right now as we see more patients with arthritis and younger patients with complex anatomical issues. Until 10 or 15 years ago, we didn’t have much to offer. Today, we have advanced surgical techniques and a range of implant options to restore mobility and improve patients’ quality of life. “
Dr David M. Dines, HSS Sports Medicine Surgeon
During the session, eight cases of different levels of glenoid bone insufficiency were presented for consideration by the session participants divided into groups around discussion tables. Members of an international panel of leading shoulder surgeons from the United States, France and Italy guided discussions at each table as participants formulated potential surgical approaches for each case. After the groups shared their proposed approaches in a round robin format, it was presented how the RSS handled the cases. Participants then had the opportunity to discuss and critique the solutions.
Session participants learned about the latest innovations in tackling glenoid bone loss, starting with the advanced diagnostic imaging and preoperative planning systems used at HSS, one of the institutions with this capability.
The surgical approaches presented included two bone grafting techniques: Offset Total Shoulder Arthroplasty (BIO-TSA) and Reverse Bone Offset Shoulder Arthroplasty (BIO-RSA). The latter reverses the ball and socket components of the joint for added stability. Another case illustrated an augmented glenoid implant, which uses a metal or polyethylene wedge or a larger metal plate to replace bone loss. HSS has been at the forefront of the development of augmented glenoid implants, said Dr Dines.
Three complex cases of significant bone loss have highlighted the use of patient-specific implants, the latest innovation in the field pioneered at HSS by Dr Dines and colleagues. Known as the Glenoid Arch Reconstruction System (RSV), it is used for patients with significant bone loss and supportive joint structure. “We create a personalized implant for each patient, based on 2D and 3D CT scans,” he explained. “RSV works well to treat severe bone loss in patients with advanced rheumatoid arthritis, after tumor removal or for revisions.” Dr Dines said he was eager to present the results of the treatment of around 75 SHS patients with RSV at next year’s AAOS annual meeting.
“This is an exciting time for the advancement of shoulder arthroplasty,” he concluded. “Our interactive session sparked many fruitful discussions which I hope will lead to increased shared learning and the development of more innovations to improve patient outcomes.”